Assessment of the Reach, Usability, and Perceived Impact of “Talking Is Power”: A Parental Sexual Health Text-Messaging Service and Web-Based Resource to Empower Sensitive Conversations with American Indian and Alaska Native Teens
Abstract
:1. Background
Overview of Talking Is Power Text Message Service
2. Methods
2.1. Study Design and Population
2.2. Data Collection and Management
3. Measurements
4. Data Analysis
5. Results
5.1. Website and Text-Message Analytics and Service Reach
Talking Is Power Text-Message Service
6. Demographic Information
7. Talking Is Power Series Satisfaction and Usability
8. Measure of Perceived Impact
9. Participant Feedback
10. Discussion
11. Limitations
12. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
- Martin, J.A.; Hamilton, B.E.; Osterman, M.J.; Curtin, S.C.; Matthews, T.J. Births: Final data for 2013. National vital statistics reports: From the Centers for Disease Control and Prevention, National Center for Health Statistics. Natl. Vital Stat. Syst. 2015, 64, 1–65. [Google Scholar]
- Centers for Disease Control and Prevention. STDs in Racial and Ethnic Minorities. Division of STD Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention; CDC: Atlanta, GA, USA, 2017.
- Centers for Disease Control and Prevention and Indian Health Service. Indian Health Surveillance Report—Sexually Transmitted Diseases 2009; CDC Department of Health and Human Services: Atlanta, GA, USA, 2012. Available online: http://www.cdc.gov/std/stats/ihs/ihs-surv-report-2009.pdf (accessed on 28 May 2021).
- De Ravello, L.; Tulloch, S.; Taylor, M. We will be known forever by the tracks we leave: Rising up to meet the reproductive health needs of American Indian and Alaska Native youth. Am. Indian Alsk. Nativ. Ment. Health Res. 2012, 19, i–x. [Google Scholar] [CrossRef]
- Kaufman, C.E.; Shelby, L.; Mosure, D.J.; Marrazzo, J.; Wong, D.; de Ravello, L.; Rushing, S.C.; Warren-Mears, V.; Neel, L.; Eagle, S.J.; et al. Within the Hidden Epidemic: Sexually Transmitted Diseases and HIV/AIDS Among American Indians and Alaska Natives. Sex. Transm. Dis. 2007, 34, 767–777. [Google Scholar] [CrossRef] [PubMed]
- Craig Rushing, S.; Gaston, A.; Kaufman, C.; Markham, C.; Jessen, C.; Gorman, G.; Torres, J.; Black, K.; Shegog, R.; Koogei Revels, T.; et al. Using technology to promote health and wellbeing among American Indian and Alaska native teens and young adults. In Indigenous People and Mobile Technologies; Dyson, L.E., Grant, S., Hendriks, M., Eds.; Routledge: New York, NY, USA, 2016. [Google Scholar]
- Fuentes, M.; Garcia, O.; Garcia, F. Protective and Risk Factors for Adolescent Substance Use in Spain: Self-Esteem and Other Indicators of Personal Well-Being and Ill-Being. Sustainability 2020, 12, 5962. [Google Scholar] [CrossRef]
- Fuentes, M.C.; Alarcón, A.; García, F.; Gracia, E. Use of alcohol, tobacco, cannabis and other drugs in adolescence: Effects of family and neighborhood. An. Psicol. 2015, 31, 1000–1007. [Google Scholar] [CrossRef]
- Martinez, I.; Garcia, F.; Musitu, G.; Yubero, S. Family socialization practices: Factor confirmation of the Portuguese version of a scale for their measurement. Rev. Psicodidact. 2012, 17, 159–178. [Google Scholar]
- Gallarin, M.; Torres-Gomez, B.; Alonso-Arbiol, I. Aggressiveness in Adopted and Non-Adopted Teens: The Role of Parenting, Attachment Security, and Gender. Int. J. Environ. Res. Public Health 2021, 18, 2034. [Google Scholar] [CrossRef]
- Ridao, P.; López-Verdugo, I.; Reina-Flores, C. Parental Beliefs about Childhood and Adolescence from a Longitudinal Perspective. Int. J. Environ. Res. Public Health 2021, 18, 1760. [Google Scholar] [CrossRef]
- Chen, C.S.; Farruggia, S. Culture and Adolescent Development. Online Read. Psychol. Cult. 2002, 6. [Google Scholar] [CrossRef]
- Darling, N.; Steinberg, L. Parenting style as context: An integrative model. Psychol. Bull. 1993, 113, 487–496. [Google Scholar] [CrossRef]
- Branstetter, S.A.; Furman, W. Buffering Effect of Parental Monitoring Knowledge and Parent-Adolescent Relationships on Consequences of Adolescent Substance Use. J. Child Fam. Stud. 2012, 22, 192–198. [Google Scholar] [CrossRef] [PubMed]
- Whitesell, N.R.; Kaufman, C.E.; Keane, E.M.; Crow, C.B.; Shangreau, C.; Mitchell, C.M. Patterns of substance use initiation among young adolescents in a Northern Plains American Indian tribe. Am. J. Drug Alcohol Abuse 2012, 38, 383–388. [Google Scholar] [CrossRef] [PubMed]
- Griese, E.R.; Kenyon, D.B.; McMahon, T.R. Identifying sexual health protective factors among Northern Plains American Indian youth: An ecological approach utilizing multiple perspectives. Am. Indian Alsk. Nativ. Ment. Health Res. 2016, 23, 16–43. [Google Scholar] [CrossRef] [PubMed]
- Power to Decide (Formerly the National Campaign to Prevent Teen and Unplanned Pregnancy). In Survey Says: Parent Power; Washington, DC, USA, 2016; Available online: https://powertodecide.org/what-we-do/information/resource-library/parent-power-october-2016-survey-says (accessed on 20 May 2021).
- Chewning, B.; Douglas, J.; Kokotailo, P.K.; Lacourt, J.; Clair, D.S.; Wilson, D. Protective factors associated with American Indian adolescents’ safer sexual patterns. Matern. Child Health J. 2001, 5, 273–280. [Google Scholar] [CrossRef] [PubMed]
- Hellerstedt, W.L.; Peterson-Hickey, M.; Rhodes, K.L.; Garwick, A. Environmental, Social, and Personal Correlates of Having Ever Had Sexual Intercourse Among American Indian Youths. Am. J. Public Health 2006, 96, 2228–2234. [Google Scholar] [CrossRef] [PubMed]
- Stanton, B.; Cole, M.; Galbraith, J.; Li, X.; Pendleton, S.; Cottrell, L.; Marshall, S.; Wu, Y.; Kaljee, L. Randomized trial of a parent intervention: Parents can make a difference in long-term adolescent risk behaviors, perceptions, and knowledge. Arch. Pediatric Adolesc. Med. 2004, 158, 947–955. [Google Scholar] [CrossRef] [Green Version]
- Wu, Y.; Stanton, B.F.; Galbraith, J.; Kaljee, L.; Cottrell, L.; Li, X.; Harris, C.V.; D’Alessandri, D.; Burns, J.M. Sustaining and Broadening Intervention Impact: A Longitudinal Randomized Trial of 3 Adolescent Risk Reduction Approaches. Pediatrics 2003, 111, e32–e38. [Google Scholar] [CrossRef] [Green Version]
- Santa Maria, D.; Markham, C.; Bluethmann, S.; Mullen, P.D. Parent-based adolescent sexual health interventions and effect on communication outcomes: A systematic review and meta-analyses. Perspect. Sex. Reprod. Health 2015, 47, 37–50. [Google Scholar] [CrossRef] [Green Version]
- Sequist, T.D.; Cullen, T.; Acton, K.J. Indian Health Service Innovations Have Helped Reduce Health Disparities Affecting American Indian And Alaska Native People. Health Aff. 2011, 30, 1965–1973. [Google Scholar] [CrossRef]
- Carroll, M.; Cullen, T.; Ferguson, S.; Hogge, N.; Horton, M.; Kokesh, J. Innovation in Indian Healthcare: Using Health Information Technology to Achieve Health Equity for American Indian and Alaska Native Populations. Perspect. Health Inf. Manag. 2011, 8, 1d. [Google Scholar]
- Hiratsuka, V.Y.; Moore, L.; Avey, J.P.; Dirks, L.G.; Beach, B.D.; Dillard, D.A.; Novins, D.K.; Pearson, C.; El-Khatib, Z. An Internet-Based Therapeutic Tool for American Indian/Alaska Native Adults with Posttraumatic Stress Disorder: User Testing and Developmental Feasibility Study. JMIR Form. Res. 2019, 3, e13682. [Google Scholar] [CrossRef] [PubMed]
- Stotz, S.; Brega, A.G.; Lockhart, S.; Hebert, L.E.; Henderson, J.N.; Roubideaux, Y.; Moore, K. An online diabetes nutrition education programme for American Indian and Alaska Native adults with type 2 diabetes: Perspectives from key stakeholders. Public Health Nutr. 2021, 24, 1449–1459. [Google Scholar] [CrossRef] [PubMed]
- National Telecommunication and Information Administration. Exploring the Digital Nation: Embracing the Mobile Internet. 2014. Available online: https://www.ntia.doc.gov/files/ntia/publications/exploring_the_digital_nation_embracing_the_mobile_internet_10162014.pdf (accessed on 8 August 2021).
- Kaufman, C.E.; Schwinn, T.M.; Black, K.; Keane, E.M.; Crow, C.K.B. The Promise of Technology to Advance Rigorous Evaluation of Adolescent Pregnancy Prevention Programs in American Indian and Alaska Native Tribal Communities. Am. J. Public Health 2016, 106, S18–S20. [Google Scholar] [CrossRef] [PubMed]
- Stephens, D.; Peterson, R.; Singer, M.; Johnson, J.; Rushing, S.C.; Kelley, A. Recruiting and Engaging American Indian and Alaska Native Teens and Young Adults in a SMS Help-Seeking Intervention: Lessons Learned from the BRAVE Study. Int. J. Environ. Res. Public Health 2020, 17, 9437. [Google Scholar] [CrossRef]
- Craig Rushing, S.; Stephens, D.; Shegog, R.; Torres, J.; Gorman, G.; Jessen, C.; Gaston, A.; Williamson, J.; Tingey, L.; Lee, C.; et al. Healthy Native Youth: Improving Access to Effective, Culturally-Relevant Sexual Health Curricula. Front. Public Health 2018, 6, 225. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Healthy Native Youth. Talking is Power: A Text Messaging Service for Parents and Caring Adults. 2020. Available online: https://www.healthynativeyouth.org/wp-content/uploads/2020/03/One-Pager_TalkingIsPower_FINAL.pdf (accessed on 6 June 2021).
- Healthy Native Youth. Talking is Power: Tools for Parents. 2020. Available online: https://www.healthynativeyouth.org/resources/talking-is-power-tools-for-parents/ (accessed on 6 June 2021).
- 13 Important Metrics for Your Press Release Distribution. Available online: https://skograndpr.com/2018/09/20/13-important-metrics-for-your-press-release-distribution/ (accessed on 3 August 2021).
- Escobar-Chaves, S.L.; Shegog, R.; Moscoso-Alvarez, M.R.; Markham, C.; Tortolero-Luna, G.; Peskin, M.; Tortolero, S. Cultural Tailoring and Feasibility Assessment of a Sexual Health Middle School Curriculum: A Pilot Test in Puerto Rico. J. Sch. Health 2011, 81, 477–484. [Google Scholar] [CrossRef]
- Faulkner, L. Beyond the five-user assumption: Benefits of increased sample sizes in usability testing. Behav. Res. Methods Instruments Comput. 2003, 35, 379–383. [Google Scholar] [CrossRef]
- Markham, C.M.; Shegog, R.; Leonard, A.D.; Bui, T.C.; Paul, M.E. +CLICK: Harnessing web-based training to reduce secondary transmission among HIV-positive youth. AIDS Care 2009, 21, 622–631. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Nielsen, J. Usability Engineering; Morgan Kaufmann: Oxford, UK, 1995. [Google Scholar]
- Shegog, R.; Peskin, M.F.; Markham, C.; Thiel, M.; Karny, E.; Addy, R.C.; Johnson, K.A.; Tortolero, S. It’s Your Game-Tech: Toward Sexual Health in the Digital Age. Creat. Educ. 2014, 05, 1428–1447. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Shegog, R.; Markham, C.M.; Leonard, A.; Bui, T.; Paul, M. “+CLICK”: Pilot of a web-based training program to enhance ART adherence among HIV-positive youth. AIDS Care 2011, 24, 310–318. [Google Scholar] [CrossRef] [PubMed]
- Shegog, R.; Markham, C.M.; Peskin, M.; Dancel, M.; Coton, C.; Tortolero, S. “It’s Your Game”: An innovative multimedia virtual world to prevent HIV/STI and pregnancy in middle school youth. Stud. Health Technol. Inform. 2007, 129, 17911862. [Google Scholar]
- What Is Bounce Rate? And How to Quickly Improve It. Available online: https://backlinko.com/hub/seo/bounce-rate (accessed on 3 August 2021).
- Visibility Reports—Metric Definitions. Available online: http://vrhelp.mediaroom.com/definitions (accessed on 3 August 2021).
- Turner, C.W.; Lewis, J.R.; Nielsen, J. Determining Usability Test Sample Size. In International Encyclopedia of Ergonomics and Human Factors, 2nd ed.; Karwowski, W., Ed.; CRC Press: Boca Raton, FL, USA, 2006; Volume 3. [Google Scholar]
- Gimenez-Serrano, S.; Garcia, F.; Garcia, O.F. Parenting styles and its relations with personal and social adjustment beyond adolescence: Is the current evidence enough? Eur. J. Dev. Psychol. 2021, 18, 1–21. [Google Scholar] [CrossRef]
- RankMonsters. Website Analytics Benchmarks. 2019. Available online: https://rankmonsters.org/website-analytics-benchmarks/ (accessed on 8 August 2021).
- García, J.F.; Pascual, J.; Frías, M.D.; Van Krunckelsven, D.; Murgui, S. Design and power analysis: n and confidence intervals of means. Psicothema 2008, 20, 933–938. [Google Scholar] [PubMed]
Series Usability Question | Scale |
---|---|
How likely is it that you would recommend this series to a friend or colleague? | 0–10 |
How well do the prompts relate to you? | 5-point Likert scale (Extremely well–Not at all well) |
How would you rate the quality of the images, text, and links? | 5-point Likert scale (Very high quality–Very low quality) |
How likely are you to sign up for a similar series on a different topic? | 5-point Likert scale (Extremely likely–Not at all likely) |
Did the series help spark sensitive conversations with your child/young adult? | (No change/Yes, we’re talking more/Other changes) |
Demographic Variables | Frequency (n) | n (%) | Mean (SD) |
---|---|---|---|
Gender (n = 98) * | 0.9184 (0.3709) | ||
Male | 10 | 10 | |
Female | 87 | 89 | |
Other | 1 | 1 | |
Age of Child/Youth (n = 96) * | 1.4063 (0.8894) | ||
Elementary School | 18 | 19 | |
Middle School | 29 | 30 | |
High School | 41 | 43 | |
Older | 8 | 8 | |
State of Residence (n = 98) * | |||
Alaska | 15 | 16 | |
Washington | 13 | 13 | |
Oregon | 13 | 13 | |
California | 12 | 12 | |
Oklahoma | 11 | 11 | |
New Mexico | 9 | 10 | |
Michigan | 3 | 3 | |
Arizona | 3 | 3 | |
Montana | 3 | 3 | |
Florida | 3 | 3 | |
Wyoming | 2 | 2 | |
Wisconsin | 2 | 2 | |
Arkansas | 1 | 1 | |
North Carolina | 1 | 1 | |
Iowa | 1 | 1 | |
Missouri | 1 | 1 | |
Nebraska | 1 | 1 | |
Virginia | 1 | 1 | |
New York | 1 | 1 | |
Texas | 1 | 1 | |
Minnesota | 1 | 1 |
Series Usability Category | Scale | Post-Test (n%) |
---|---|---|
Recommend series to a friend (n = 12) | 0–10 | 0–6 (17%) |
7–8 (8%) | ||
9–10 (75%) | ||
Relation to prompts (n = 13) | 5-point Likert scale (Extremely well-Not at all well) | Not at all well 0 (0%) |
Not so well 2 (15%) | ||
Somewhat well 2 (15%) | ||
Very well 5 (39%) | ||
Extremely well 4 (31%) | ||
Quality of Images Texts and Links (n = 13) | 5-point Likert scale (Very high quality-Very low quality) | Very low quality 0 (0%) |
Low quality 0 (0%) | ||
Neither high nor low quality 2 (15%) | ||
High quality 3 (23%) | ||
Very high quality 8 (62%) | ||
Sign up for similar series (n = 13) | 5-point Likert scale (Extremely likely-Not at all likely) | Not at all likely 1 (8%) |
Not so likely 0 (0%) | ||
Somewhat likely 1 (8%) | ||
Very likely 4 (30%) | ||
Extremely likely 7 (54%) | ||
Spark sensitive conversations (n = 13) | (No change/Yes, we’re talking more/Other changes) | No change 2 (15%) |
Yes, we’re talking more 6 (46%) | ||
Other changes * 5 (39%) |
Pre-survey Participant Feedback | Major Themes | Quotations |
Series helpful in initiating sensitive conversations with youth | “I manage a local health department’s sexual health program-seeking to learn more and better serve our whole community.” “Always looking for ways to educate my sons on sexual health, relationships, etc.” “I’m a therapist, and sometimes topics come up. This is an excellent referral source. Thank you.” “We also work with native youth K-12 so this will be helpful.” “Thank you for this service! I think it will be a good reminder to keep these important conversations going with our children.” | |
Potential topics that could be addressed in similar series | “Peer pressure and bullying.” “Topics about discovering themselves and healing for youth that have went through traumatic events”. “Suicide/depression. Both my sons isolate themselves. I have a 16 and 21-year-old that is still in the home. Have set them up with therapists during COVID-19 but doesn’t seem to be helpful. I’m a single mother and work long, exhausting days. Very worried about their well-being and want to help them with being socially and physically well.” “Talking about what to do with an unwanted teen pregnancy and abortion is hard. I am prochoice.” “My teen has reactive attachment disorder. She has self-harmed once. She has said she prefers to be sad and angry by her own report. We need ways to encourage positive thinking and more genuine emotions other than sadness and anger.” “Impact of social media presence on our students.” | |
Concerns about sexual health conversations and youth sexual activity | “What age do we start talking to youth about the MMIW movement? I want youth aware, but I also don’t want to cause fear or trauma in speaking about it. Thanks!” “I don’t know how to begin the conversation with my eldest niece who is 17 going on 18.” “My son has a developmental delay, and I get concerned things such as his sexuality of sexual activity will get warped or lost for him.” “Concerned about social choices during the COVID19 lockdown restrictions lifting.” |
Post-survey Participant Feedback | Major Themes | Quotes |
Improving mode of series delivery | “Get a live person to talk with people doing the course as they do it. Avatar X never talked to me.” “Longer time in between messages? Longer overall. Thank you for the support!” “Send out more alerts.” “One thing that I have yet to come across is how to talk to a child who has intellectual or other disabilities. I modify as much as I can, but it would be helpful if you guys somehow incorporated that into this lesson. Thank you I appreciated this-helped me out and kept me current with today’s slang topics etc.” | |
Positive feedback/Other adolescent health topics | “Nothing. I like the frequency, the reminders and all the materials. Thank you!” “It would be nice to have this series address other adolescent health topics.” |
Publisher’s Note: MDPI stays neutral with regard to jurisdictional claims in published maps and institutional affiliations. |
© 2021 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
Share and Cite
Sacca, L.; Craig Rushing, S.; Markham, C.; Shegog, R.; Peskin, M.; Hernandez, B.; Gaston, A.; Singer, M.; Trevino, N.; Correa, C.C.; et al. Assessment of the Reach, Usability, and Perceived Impact of “Talking Is Power”: A Parental Sexual Health Text-Messaging Service and Web-Based Resource to Empower Sensitive Conversations with American Indian and Alaska Native Teens. Int. J. Environ. Res. Public Health 2021, 18, 9126. https://doi.org/10.3390/ijerph18179126
Sacca L, Craig Rushing S, Markham C, Shegog R, Peskin M, Hernandez B, Gaston A, Singer M, Trevino N, Correa CC, et al. Assessment of the Reach, Usability, and Perceived Impact of “Talking Is Power”: A Parental Sexual Health Text-Messaging Service and Web-Based Resource to Empower Sensitive Conversations with American Indian and Alaska Native Teens. International Journal of Environmental Research and Public Health. 2021; 18(17):9126. https://doi.org/10.3390/ijerph18179126
Chicago/Turabian StyleSacca, Lea, Stephanie Craig Rushing, Christine Markham, Ross Shegog, Melissa Peskin, Belinda Hernandez, Amanda Gaston, Michelle Singer, Nicole Trevino, Chrystial C. Correa, and et al. 2021. "Assessment of the Reach, Usability, and Perceived Impact of “Talking Is Power”: A Parental Sexual Health Text-Messaging Service and Web-Based Resource to Empower Sensitive Conversations with American Indian and Alaska Native Teens" International Journal of Environmental Research and Public Health 18, no. 17: 9126. https://doi.org/10.3390/ijerph18179126